Wednesday, July 21, 2010

The Right To Remain Ignorant

In my column for this week, I analyze an Oklahoma abortion law that protects doctors from liability for failure to disclose fetal anomalies to their patients. The column discusses the important ways in which such a law differs from the more common abortion legislation (providing for waiting periods, parental consent or notification, etc.) and is arguably more legitimate as a result.

In this post, I want to focus on a different Oklahoma abortion law that was passed on the same day as the non-disclosure measure. This law requires that women seeking an abortion must be shown a fetal ultrasound. It specifically mandates that a doctor or technician set up the monitor so the woman can see it and describe the heart, limbs and organs of the fetus.

There is, of course, a certain irony in Oklahoma's requiring that providers give pregnant patients unwanted information about their fetuses even as it simultaneously protects providers' freedom to conceal other wanted information from their patients. Putting the hypocrisy aside, however, it is worth considering whether it is appropriate to compel people to confront the consequences of their morally-freighted decisions.

Imagine, for example, that before deciding whether or not to register as an organ donor on one's driver's license, a driver was required to listen to an information session. The session might include facts about the people on organ registry waiting lists, the physical and emotional suffering that they and their loved ones undergo as they hope against hope for a donation, and the number of compatible donors whose potentially life-giving organs are buried in the ground every year when they could have saved lives, if people had only checked off the donor box on their driver's licenses. If donation is the right thing to do -- but not something we feel may be appropriately forced on anyone -- such an information session would seem quite appropriate.

Imagine now that those who sell animal products had to include on the packaging some of the facts about the animals who suffered and died to make the products. For example, containers of cow's milk would, instead of the deceptive drawings of contented creatures grazing around with their children, have to include a list (or some subset) of the following facts:

After they give birth, cows exhibit the same maternal behavior and reciprocal attachment to their babies that humans do.

Baby calves are taken away from their mothers long before they would naturally stop nursing, a separation accompanied by both calves and mothers bellowing and exhibiting great distress.

This separation occurs so that milk that cows produce for their babies can be extracted instead for human consumption.

Calves, if male, are considered low-quality byproducts of dairy and are killed as babies to make veal.

Female cows are slaughtered along with their babies after only a few years of life, when their milk production drops off. Many are pregnant when slaughtered.

Transporting the animals to slaughter subjects them to extremes of temperature, crowding, and pain, and many can barely walk when they arrive at the slaughterhouse.

The slaughter process itself is terrifying to animals, who produce adrenaline and other stress hormones and vocalize loudly in a manner that sounds like human screaming.

After their throats are cut, many cows remain conscious for several minutes as they suffocate to death by drowning in their own blood.

Humans are the only mammals who consume another animal's mammary secretions as adults.

Countries in which people consume little or no dairy have far lower rates of osteoporosis than the United States.

I would think that people should have this information before they decide to purchase and support the products of the dairy industry.

How is any of this relevant to the fetal information sessions to which Oklahoma and other states subject women seeking an abortion? It demonstrates that people confront life-and-death moral decisions in many arenas well outside of the abortion context. Yet only when the decision-maker is a woman and the decision to be made is about whether to remain pregnant do legislatures see fit to require people to face the reality of what they are about to do.

I am of the view that it would be beneficial for people to face and understand the truth about the violence from which we so often turn our heads. People should be thinking about the other beings, human and nonhuman alike, who will suffer and die because of choices that they make and that could easily be made differently. I understand, of course, that people want to be able to make their choices and put the harmful consequences out of sight and out of mind. This desire, however, is ultimately destructive. It emotionally externalizes the true costs of the decisions that we make every day.

Such externalization is ubiquitous, however, such that one has to wonder why, when it comes to pregnant women who want to terminate their pregnancies, the government sees fit to make an exception to it. Such gross under-inclusiveness suggests that rather than ensuring that people have enough information to make informed moral decisions in their lives, those who support fetal information sessions are concerned exclusively with the sexual-moral health of women, an exclusivity that bespeaks sexism.

Of course, the kinds of messages that are legislatively required are designed to achieve a preferred result. So, when you suggest that an organ donor be shown a video of wait-listed people in desperate need of an organ, the purpose is to promote organ donation. But if the desire were to discourage organ donation, one could show a video detailing the surgical procedure by which organs are harvested and highlight the lack of bodily integrity that results from harvesting organs. An open casket is not likely to follow the organ harvesting, and those who envision the stereotypical funeral with corpse on display is likely to be turned off from organ donation. All of this is to say that OK's law is more of the same paternalistic, result-oriented legislation designed to burden a woman's choice.

The message from the non-disclosure legislation is that a woman doing her due diligence when selecting an OBGYN is wise to inquire as to the political ideology of the medical provider and his/her feelings about full disclosure even in the absence of liability. That doesn't seem right, and in practice, is very unlikely to occur. My experience has been that patients don't ask doctors any questions before going for services, let alone personal ones like political ideology. This assumes, of course, that the patient understands that medical disclosures are discretionary on the doctor's part -- which I doubt.

I don't find the column convincing and wonder in particular why promoting fraud (the implication is that the fetus is okay) for what is quite possibly moral based reasons is acceptable.

Also, I think you miss the point that even if you don't abort, it's can be important to know you will have a baby with some problems. Economic and emotional prep come tom mind. Thus, the policy is imho negligence.

Finally, you suggest it causes us to face up to morally questionable decisions. But various abortions involve just that -- e.g., aborting after rape (should we trick women into thinking the child is hers or encourage that by not allowing liability if we do?) or poverty. Likewise, we have the right to "discriminate" in private. We can choose, e.g., not to date a person of a different race.

Interfering with choice in this fashion connects the law with other burdensome legislation on dubious moral ground as well.

As to the current issue, clearly there is a selective rule here, just as the state selectively targets abortion for any number of things, even when having a child might also be something warranting deeper thought and concern.

Also, to the degree the ultrasound is invasive, that alone is problematic. Anyway, I don't think there it is right to force people to hear descriptions, particularly since many know it already and it is not likely to change any minds. "Oh! the fetus has a heart,you say? Well, let me have my rapist's baby, then! Let me have a baby at 14!" Or, "well, I will have it, but thanks for making my decision be that much more well rounded!"

I am sympathetic to the animal comparison, but we are talking about "potential HUMAN life" here, so it isn't quite on point. But, yes, the selective nature of the law, only certain decisions targeted, is one more reason it is wrong.

The first paragraph should have referenced selective religious/moral reasons of the physician that is contrary to that of the woman. This isn't what medical decisions should rest on and as another comment notes it is not what people generally look out for when going to their doctor.

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